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Study Suggests How Doctors Can Respond To Discrimination From Patients

The issue of discrimination is prevalent in health care. But the focus has been largely on the mistreatment of trainees or interns by supervisors, or towards patients. Having it the other way around – discrimination against doctors by patients and their families – has received much less attention, leaving doctors and other health care workers groping in the dark about how to handle such situations.

To shed some light on this, Dr. Emily Whitgob from Stanford University and colleagues wrote an article published in Academic Magazine on how doctors can cope with discrimination, according to Medscape.

The paper comes after a Facebook post by Dr. Tamika Cross, a resident OB-GYN at the University of Texas-Houston, went viral a few weeks ago. In the post, Cross describes how a flight attendant on Delta Airlines blatantly discriminated her and her profession during a medical emergency on the plane. The attendant told her, “We are looking for actual physicians or nurses or some type of medical personnel, we don’t have time to talk to you,” when she volunteered to assist the unresponsive patient, The Guardian reports. The incident started the hashtag #WhatADoctorLooksLike, gaining massive support across the world.

Whitgob has her own story to tell. A patient had asked an intern if her last name was Jewish, stating that,

I don’t want a Jewish doctor.

Whitgob is Jewish, and the situation made both her and the intern uncomfortable, reports CNN.

In the article, doctors should do four things when faced with discrimination: assess illness acuity, cultivate a therapeutic alliance, depersonalize the event, and ensure a safe learning environment for trainees. Whitgob says, “We believe these approaches begin to form a model that can be taught to trainees and faculty alike to ensure adequate preparation for these events.”

Studies over the last five years show that mistreatment of medical trainees is a prevalent problem in the US. Some 17 to 95% of trainees have reported experiencing some form of abuse, the most common being verbal harassment. Discrimination against gender was at4%, while against race was the highest at 19%.

Medical schools are now mandated to report all trainee mistreatment cases. In 2013, the Accreditation Council for Graduate Medical Education was also asked to look into resident mistreatment. But only one study, so far, has examined the mistreatment of trainees by patients, which account for close to 40% of all discrimination encounters that residents experience. A 2015 survey of pediatric doctors at Stanford University reported that 50% of respondents did not know how to address mistreatment by patients.

Whitgob and the team conducted a study to determine strategies for doctors and trainees to employ should they experience any form of discrimination. They interviewed 13 physicians from Stanford University’s Program Evaluation Committee, each of whom completed a one-on-one interview for 75 minutes to discuss the appropriate responses to various scenarios.

The team then analyzed the interviews and identified the four themes in how doctors and trainees can respond to discrimination by patients and their families.

Based on the study, Whitgob and other doctors emphasized the need to come up with institutional policies on all levels to address the issue. They wrote, “Processes must be in place to ensure protection of trainees and the faculty who train them, and to ensure continuity of care for patients needing transfer when they refuse to be treated by the team.”